Understanding the veteran experience
Veterans and their families face unique experiences during a military career, and in transitioning to civilian life. Military life can involve significant challenges, not least the exposure to life and death situations. For many veterans, military service and operational deployment can also lead to a strong sense of identity and belonging. For clinicians working with veterans, demonstrating an understanding of the military experience can greatly enhance the therapeutic alliance and the delivery of effective treatment. Veterans are more likely to engage with health care practitioners whom they feel understand, or seek to understand, their mental health problems within the context of their military service.
Online course on understanding the military experience
DVA offers a free online course that provides information about the military experience, treatment eligibility and basic information about common mental health presentations and their impact on family and carers.
You will require the following code to access the course: ext
- Approximately 1.4 million Australian men and women have served with Australian military forces in wars and peacekeeping operations since Federation. Amongst those alive today, the majority are males aged 60 years and over. World War II veterans are the largest group (around 77,400), followed by Vietnam veterans (around 47,000) and approximately 14,700 veterans of the Korean War, Malayan Emergency Confrontation and other operations in Southeast Asia.
- The 1990s saw the Australian Defence Force (ADF) engaged in a new wave of overseas deployments, with approximately 1200 personnel serving in the first Gulf War and an estimated 5000 engaged in peacekeeping operations in places such as Cambodia, Somalia and Rwanda. Since 1999, it is estimated that a further 30,000 ADF personnel have served in peacekeeping operations and in areas of conflict, including East Timor, Afghanistan and Iraq (DVA annual report, 2011).
The mental health needs of veterans are diverse and are rapidly changing:
- For World War II, Korean and Vietnam veterans, issues of ageing and chronic disease can be an important consideration. Depression, alcohol misuse and dependence and PTSD are the most common mental issues encountered in this group
- Currently serving and recently discharged ADF personnel have engaged in a range of warlike, peacekeeping and peacemaking deployments, as well as disaster response and border protection operations. These younger, or ‘contemporary’ veterans are more likely to have experienced multiple, high tempo deployments. Recent conflicts and peacekeeping missions arguably involve fundamentally different types of conflict to previous engagements. For example, deployment to the Middle East may involve the ongoing threat of insurgent combatants, urban conflict amongst non-combatants, and increased prevalence of Improvised Explosive Devices. Many veterans describe the extraordinary demands of constantly facing the threat of death or serious injury. Additionally, complex rules of engagement and lines of command within multinational forces can increase the level of stress on Defence members on deployment, particularly in peacekeeping and peacemaking operations, as can the conflict with personal belief systems in these and border protection operations.
- Apart from deployment cycles, frequent relocations within Australia can result in a sense of dislocation for contemporary veterans and their families, and combined with the often remote locations of ADF bases, this can limit consistent access to medical and mental health services. Currently serving veterans may also be concerned about career progression and limited opportunities for re-deployment when mental health issues are identified.
For many Defence members, a deployment is the pinnacle of their career, where years of preparation and training are put into action, either in war fighting, peacekeeping, peacemaking or humanitarian missions. All deployments may involve high risks of exposure to trauma, as well as the threat of serious injury, death and loss. Some ex-ADF members may not have participated in deployment that involved war or peacekeeping duties but may nonetheless have been deeply affected by experiences such as humanitarian deployments (e.g. the operation in Aceh following the 2004 Tsunami) or training accidents (e.g., the 2006 Black Hawk training accident or the 1964 HMAS Melbourne-Voyager collision that resulted in 82 deaths).
Regardless of their timing or nature, a veteran’s experiences can have a lasting and profound influence. Most veterans join the services as young adults, an important time in life for shaping values, beliefs and attitudes. Because they were socialised into military culture at a time when they were malleable, many will have adopted military values and ideals as their own. Many high impact experiences will have occurred during times of extreme stress, in some cases during life-threatening situations. What is learned under these conditions can be resistant to change because it is associated with survival.
While some of these experiences can help protect a veteran from the impact of stress and mental health problems, they can also lead to tension, particularly in a civilian setting. Some military or deployment experiences can also contribute to, or exacerbate mental health problems. These experiences do not apply to all veterans, nor are mental health problems an inevitable consequence of the events experienced. It is important to note that while some veterans readily identify the impact of service-related experiences on their current feelings and behaviours, for others, the connection may not be as evident, particularly if habits linked to their military experience were formed many years ago.
Recommended readings and online resources about military culture
These resources provide further background and detail on the experiences of veterans and their families before, during and after deployment.
|DVA mental health and wellbeing after military service booklet (PDF) contains useful information about experiences and issues that may arise during transition from military to civilian life, for ex-serving members and their families.|
|Defence community organisation deployment Support booklet||This booklet from the Australian defence community organisation provides information to support families during and after a family member goes on deployment. Other useful resources developed by the Defence Community Organization can be accessed here.|
|US website - post deployment issues||A US based webpage offering a range of videos, fact sheets and online book resources about post deployment mental health.|
|Returning from the war zone||Produced by the US Department of Veterans Affairs, this resource has stories and videos highlighting the experiences of American veterans and their families in adjusting to deployment and returning home.|
Accessing DVA Services
Free health care
The Department of Veterans’ Affairs (DVA) can pay for certain mental health treatment for veterans whatever the cause (that is, the condition does not have to be related to service in the Australian Defence Force). Conditions covered are:
- Posttraumatic Stress Disorder (PTSD);
- Anxiety disorders;
- Depression; or
- Alcohol and substance use disorders.
Currently, those with operational service are eligible, as are many with peacetime service. It is planned to expand eligibility to include anyone who has had permanent service in the Australian Defence Force, whatever the length or type of service.
These arrangements are also known as “non-liability health care”. Click here for more information on these arrangements, including a factsheet, eligibility information sheet, client application forms and access to an e-learning programme.
You can also call the DVA provider enquiry line on 1300 550 457 (from metropolitan areas) or 1800 550 457 (from non-metropolitan areas) for further information.
VVCS - Veterans and Veterans Families Counselling Service
The Veterans and Veterans Families Counselling Service (VVCS) provides free and confidential, nationwide counselling and support for war and service-related mental health conditions, including anxiety, depression, PTSD and adjustment disorder. Support is also available for relationship and family matters that can arise due to the unique nature of military service.
VVCS clinicians have an understanding of military culture and work with clients to find effective solutions for improved mental health and wellbeing. Services include:
- individual, couple or family counselling and support for those with more complex needs;
- services to enhance family functioning and parenting;
- after-hours crisis telephone counselling and support;
- group programs to develop skills and enhance support;
- information, education and self-help resources; and
- referrals to other services or specialised treatment programs.
VVCS counsellors are available 24 hours a day, 7 days a week on 1800 011 046 (free call from landlines and some mobile networks).
Mental Health Services and Resources
Providers can refer DVA clients to a range of veteran-specific services and resources. To find out more about the mental health resources you can recommend to your veteran patient, including to which disorder the resources are most applicable, click here.
How to become a DVA provider
Most health providers can treat DVA clients once they are accepted as a provider by Medicare and have completed a DVA Recipient Created Tax Invoice agreement. Neuropsychologists and Social Workers will need to contract directly with DVA in order to do business with us. Please phone 1300 550 457 for more information.
Health care providers are to provide services to veterans consistent with the DVA fee schedule. Where a health care provider accepts a DVA repatriation health card (Gold or White) as payment for treatment provided, the provider agrees to accept the DVA fees and conditions for the services provided. Importantly this means that DVA clients will not be charged for treatment provided under DVA health care arrangements.
Having a family member in the Australian Defence Force (ADF) can involve a great deal of pride and provide a strong sense of community. Members often describe the military in familial terms, due to the strong bonds, shared values and sense of belonging afforded by Defence careers. These positive identifications can also extend to ex-ADF members, veterans and their families. Military life can also involve difficulties for families, particularly in managing the expectations of military and civilian cultures. Values that may be important in a military context such as discipline and obedience to authority may not always mesh with civilian behaviours and values, such as negotiation and compromise. The practical realities of military life have perhaps the most significant impacts on family functioning, including long absences during training and deployments, changes in roles and responsibilities, adapting to regular relocations, and managing upheavals in partners’ careers and children’s schooling.
Military families have to cope with the potential for exposure to extraordinary risks, such as the injury or death in combat of a family member. A potentially challenging period for some is the transition out of the military. Separation from Defence can involve changes in location, finances and family roles (e.g., the partner of a veteran becoming the main income earner).
When a serving member is deployed (or absent for long periods during pre-deployment training) the whole family is affected. During deployment, family members have to cope with the absence of the serving member and uncertainty around his or her safety. They also have to adapt by taking on new roles. For example, partners may have to take sole responsibility for managing budgets, and older children may have to care for their siblings. The nature of military postings may mean that additional support from friends or family is not readily available. These roles and relationships often have to be renegotiated once the serving member returns. Reintegration into family life can also be hampered by mental health issues exacerbated by, or developed since deployment.
The emotional and physical impact of exposure to combat, humanitarian, peacekeeping and peacemaking experiences on veterans can have long-term consequences for many families. For example, recurring depression, chronic substance abuse or posttraumatic stress disorder (PTSD) may lead to long-term conflict or disengagement within the family. Anxiety about the veteran’s mental health and taking on the role of carer can also take a toll on family members.
As in any family environment, mental health issues can have a significant impact upon individual family members and the functioning of the family unit. Children who have a parent with a mental health issue are more likely to experience behavioural problems, difficulties in forming and maintaining relationships, poor coping skills and academic difficulties, and are more likely to develop mental health issues themselves. Veterans’ mental health can also significantly impact upon partners. In addition to dealing with problems associated with mental health issues such as emotional withdrawal, substance abuse or suicide threats or attempts, partners may have to take on additional responsibilities in the family home, or adapt to unwanted lifestyle changes such as increased isolation from their friends and community.
The symptoms associated with PTSD (intrusive memories, hyperarousal, avoidance and negative mood) can lead to particular difficulties in family relationships. Hyperarousal can contribute to aggression and domestic violence. Avoidance can inhibit intimacy between a veteran and their partner, and reduce satisfaction with the relationship. Partners of veterans have also been said to experience vicarious trauma as a result of being exposed to their partner’s PTSD. Partners can experience anxiety, depression, social isolation and feelings of hopelessness as a result of their partner’s trauma and subsequent symptoms. Partners have talked about ‘walking on eggshells’ around their veteran partner and being afraid of the veteran’s symptoms.
Providing care to veterans in a family sensitive way
Mental health services are increasingly being delivered in ways which take into consideration the needs of families and the important role they play through treatment and recovery. Partners, children, parents and siblings of a person with a mental illness are likely to be significantly affected by that person’s condition. In most cases family members benefit greatly from accurate information, involvement in treatment, and if necessary, support to access services for themselves.
The involvement of significant others in the assessment and treatment of a veteran can have positive impacts on a veteran's recovery and helps identify the needs of family members so that they can be adequately supported or referred. Involvement of family members in assessment and treatment allows accurate, hopeful messages about support and treatment to be shared. Family members are invaluable sources of helpful information about the veteran’s mental health, providing more objective assessments of changes in the veteran’s mood and behaviour. Families can also provide support and motivation to seek help and maintain involvement in treatment. In addition, veterans may be more likely to seek help and engage with mental health services alongside their families if they believe it is of benefit to their family.
Recommended readings and online resources about families
|Beyond The Call - Stories from veterans and their families recounts experiences of Australian veterans and their families who have a mental health and/or substance abuse issue.|
|Parenting Research Centre||The Parenting Research Centre is an Australian website dedicated to supporting parents through developing resources, programs and policies based on scientific evidence.|
|The Bouverie Centre||Descriptions of family sensitive interventions: key principles and links to training. The Bouverie Centre website also has a range of other family resources.|
|Children of parents with a mental illness||COPMI has a range of resources for families and practitioners focussing on improving outcomes for children.|
|Child Family Community Australia: Research Practice and Policy Information Exchange||This website houses evidence-based publications and resources for professionals in the areas of protecting children, supporting families and strengthening communities.|
|U.S. National Child Traumatic Stress Network||The National Child Traumatic Stress Network is a US based peak body for child and adolescent post traumatic mental health. It holds a range of resources including information on children of veterans.|
|Online training on impact of deployment||The US-based Center for Deployment Psychology has online training programs on the impact of deployment and combat on families and children.|
Helping veterans and their families connect to communities
Many veterans and their family members access ex-service organisations (ESOs) for a range of services and activities, as well as to contribute their time and energy and give back to the veteran and wider communities. It is important to note that some veterans, particularly those from more recent conflicts, prefer not to identify with the ex-service community.
Military service involves the formation of strong, powerful bonds of trust and friendship. For many veterans, these connections continue after their separation from Defence, but for some these important peer relationships can diminish over time – particularly where mental health problems impact on a veteran’s capacity to socialise and seek support. Supportive social connections are a vital part of maintaining wellbeing and resilience, and are predictive of positive outcomes in managing post traumatic mental health conditions. It can be helpful for practitioners to assist veteran clients in reconnecting with their peers. Be aware that some younger veterans choose to not be connected or may feel out of place in some ex-service communities. However, there is an increasing number of groups targeted specifically to the needs and interests of contemporary veterans.
There is a list of ex-service organisations and groups that veterans might find helpful for information, support and social connection, and as a vehicle for volunteering.
Using commemoration to stay connected: Engaging in commemoration ceremonies and activities can be an important way for veterans and their families to pay respects to and honour those injured or killed in war. Please visit DVA’s commemorative activities and events page for more information.
Research and other recommended readings
|The Department of Veterans' Affairs 2013-2023 Veteran Mental Health Strategy (PDF)||The Strategy provides a ten year framework for mental health care in support of current and future veterans and their families. The strategy will ensure the Department remains responsive to the needs of existing clients while continuing to reposition itself in the context of contemporary veterans and their families.|
|The 2010 Australian Defence Force Mental Health Prevalence and Well-being Study (PDF)||This study provides prevalence figures for common mental health presentations over a 12-month period amongst currently serving ADF members.|
|Mental Health needs of Cohabiting Partners of Vietnam Veterans with Combat-Related PTSD||This research article outlines a review of the mental health support needs of partners of (US) veterans who have been receiving care for PTSD.|
|The Australian Gulf War Veterans’ Health Study is a large scale study into the health outcomes of veterans who served in the first Gulf War. Information about mental health conditions is contained in Volume 1 from page 265.|
|This 2010 report by Monash University examines the health and service use of Australian veterans and non-veterans in a longitudinal study.|
|Children and Young People in Defence Force Families||The Australian Institute of Family Studies has collated Australian and US reports on children and young people in military families.|
|PTSD in Female Veterans||This 2004 article outlines the range of difficulties associated with having a diagnosis of PTSD for female veterans in the US.|
|Timor-Leste Family Study||The 2012 Timor-Leste Family Study focussed on the potential for physical, mental or social health impacts on family members of veterans who served in Timor-Leste. The study also investigated what factors tended to protect veterans' families or place them at risk of health impacts.|